Burcu Artunc Ulkumen

Prenatal Diagnosis of Congenital High Airway Obstruction Syndrome: Report of Two Cases and Brief Review of the Literature

Congenital high airway obstruction syndrome (CHAOS) is the obstruction of the fetal upper airways, which may be partial or complete. It is usually incompatible with life. Prenatal recognition of the disease is quite important due to the recently described management options. We report here two cases of CHAOS due to tracheal atresia diagnosed by antenatal ultrasonography and fetal MRI. We also briefly review the relevant literature with the associated management options.

The Protective Effect of Granulocyte Colony-Stimulating Factor on Endometrium and Ovary in a Rat Model of Diabetes Mellitus

Aims: To evaluate the effect of granulocyte colony-stimulating factor (G-CSF) on the endometrium and ovaries in an experimental diabetes mellitus (DM) rat model. Methods: A total of 18 female Sprague-Dawley albino mature rats (8 weeks, 200-220 g) were used in this study. Diabetes was induced by intraperitoneal (i.p.) injection of streptozocin randomly in 12 rats. No drug was administered to the remainder of the rats (control group, group 1, n = 6). The other 12 rats were randomly divided into 2 groups; 1 ml/kg i.p. saline was given as vehicle to group 2 (diabetic nontreated control group, n = 6) and 100 µg/kg/day of i.p. G-CSF was given to group 3 (G-CSF-treated group, n = 6) for 4 weeks. After 4 weeks, blood samples were collected and hysterectomy with bilateral oophorectomy was performed for histopathological examination. Results: The mean endometrial gland degeneration and stromal fibrosis scores were significantly higher in group 2 compared with groups 1 and 3. Ovarian follicle degeneration, stromal degeneration and stromal fibrosis scores were significantly higher in group 2 compared with groups 1 and 3. Plasma TGF-β and malondialdehyde levels were significantly lower in groups 1 and 3 compared with group 2. Antimüllerian hormone levels were significantly lower in group 2 compared with groups 1 and 3. Conclusion: Glucose toxicity occurred severely in the ovaries and endometrium of the DM rats. After G-CSF treatment, ovarian and endometrial injury and fibrosis scores decreased significantly. The effects of G-CSF in rat models give hope to improved treatment of human DM complications such as premature ovarian failure and endometrial dysfunction.

Abnormal Elevated CA 19-9 in the Dermoid Cyst: A Sign of the Ovarian Torsion?

Dermoid cyst is the most common germ cell tumor of the ovary containing various tissue elements. Ovarian torsion is a common complication of which ultrasonographic diagnosis is confusing. We report here a 14-year-old adolescent with painless torsion of the ovary including dermoid cyst and with abnormal elevated CA 19-9 serum levels. Elevated CA 19-9 level may be related to ovarian torsion and may predict the extent of tissue necrosis.

Therapeutic effect of sunitinib on diabetes mellitus related ovarian injury: an experimental rat model study.

Abstract The aim of our study is to investigate the effect of sunitinib on diabetes mellitus related-ovarian injury and fibrosis in rat models. An experimental diabetes mellitus model was created in 16 rats, and eight rats with normal blood glucose levels were included in control group (Group-1). The diabetic rats were divided into two groups:diabetic control group (water given) – Group-2 and sunitinib treatment group – Group-3. After four weeks, bilateral oophorectomy was performed and ovaries were examined histologically. The groups were compared by Student’s t-test, analysis of variance (ANOVA) and Mann–Whitney’s U-test. There was a significant increase in no-medication (water given) diabetic rat’s ovary (Group-2) in terms of follicular degeneration, stromal degeneration, stromal fibrosis and NF-kappaB immune-expression compared with control group normal rats’ ovary (Group-1) (p < 0.0001). Stromal degeneration (p = 0.04), stromal fibrosis (p = 0.01), follicular degeneration (p = 0.02), NF-kappaB immune-expression (p = 0.001) significantly decreased in sunitinib-treated diabetic rat’s ovary (Group-3) when compared with no-medication (water given) diabetic rat’s ovary (Group-2) (p < 0.05). When we used sunitinib in the treatment of diabetic rats, ovarian injury, fibrosis and NF-kappaB immunoexpression decreased significantly. The effects of sunitinib in rat models give hope to the improved treatment of premature ovarian failure due to diabetes mellitus in humans.

The assessment of placental volume and mean gray value in preeclamptic placentas by using three-dimensional ultrasonography.

Abstract Objectives: We aimed to evaluate the placental volume and placental mean gray value in preeclampsia and healthy placentas by using three-dimensional (3D) ultrasonography and Virtual Organ Computer-aided AnaLysis (VOCAL). Methods: This case–control prospective study consisted of 27 singleton pregnancies complicated by preeclampsia and 54 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm3) was analyzed using the VOCAL imaging program, and 3D histogram was used to calculate the volumetric mean gray value (%). Results: Preeclamptic and control group consisted of 27 (mean age: 28.90 ± 5.95 years, mean gestation: 32.0 ± 4.55 weeks) and 54 (mean age: 29.48 ± 5.78 years, mean gestation: 32.61 ± 4.23 weeks) singleton pregnancies, respectively. Placental volume was significantly smaller in preeclampsia (250.62 ± 91.69 versus 370.98 ± 167.82 cm3; p = 0.001). Volumetric mean gray value of the placenta was significantly higher in preeclampsia (38.24 ± 8.41 versus 33.50 ± 8.90%; p = 0.043). Placental volume was significantly correlated with the estimated fetal weight (r = 0.319; p = 0.003). There was negative significant relation between placental volume and umbilical artery pulsatility index, resistance index and systolic/diastolic ratio (r = –0.244, p = 0.024; r = –0.283, p = 0.005; r = –0.241, p = 0.024, respectively). Conclusions: Placental volume diminishes significantly in preeclampsia, whereas volumetric mean gray values increases. This may reflect the early alterations in preeclamptic placentas, which may help to understand the pathophysiology better.

Prenatal diagnosis and fetomaternal outcomes of two cases with placental chorioangioma.

Placental chorioangiomas greater than 4 cm in diameter are rare placental tumors. They have adverse fetomaternal outcomes. We present our experience with two cases having a giant angioma and review the relevant literature.

Complete blood count parameters may have a role in diagnosis of gestational trophoblastic disease.

Objective: The goal of this study was to investigate whether gestational trophoblastic disease (GTD) and healthy pregnancy differ with respect to complete blood count parameters and these parameters can be used both to explain the pathophysiologic mechanisms and differentiate the two conditions from each other. Methods: The data obtained from 37 women with GTD and 61 healthy pregnancies (control group) regarding platelet (PLT), mean PLT volume (MPV) and PLT distribution width (PDW), and white blood cell (WBC) levels were evaluated. Patients with GTD were further subdivided into two groups composed of 20 partial mole (PM) and 17 complete mole (CM) cases. Results: PDW and WBC were lower in the GTD than the control. There were no differences for PLT and MPV. WBC was lower in PM and both WBC and PDW were lower in CM compared with control. ROC curve analysis revealed an area under curve (AUC) 75.5% for WBC and AUC 69.3% for PDW. A cut-off value was determined 8.19 for WBC with 81.0% sensitivity and 54.1% specificity. While, 15.85 were accepted for PDW, with 87.9% sensitivity and 44.4% specificity. Conclusion: Lower WBC in GTD may suggest that molar pregnancy requires a lower inflammatory reaction facilitating trophoblastic invasion. Lower PDW as an indicator of platelet activation in CM may suggest that CM requires less PLT activation than healthy pregnancy that needs stronger trophoblast invasion for normal placental development. Decreased PDW levels especially < 15.85 and WBC levels < 8.19 may alert clinicians for risk of GTD.

Foetal axillary lymphangioma with ipsilateral pes equinovarus: pitfalls in sonographic differential diagnosis (axillary lymphangioma & pes equinovarus).

Abstract Lymphangiomas are rare congenital malformations of the lymphatic system. Despite the benign histology, they are likely to grow rapidly and invade the surrounding tissues. In contrast to the cystic hygromas, lymphangiomas at the axillary region tend to have normal karyotype. However, associated hydrops makes the prognosis poor. Due to isolated few cases in the literature, the true incidence of foetal axillary lymphangiomas is not known. We present here a pre-natal ultrasonographic diagnosis of a 15-week foetus with rapidly growing axillary lymphangioma with ipsilateral foot abnormality which had normal karyotype.

The evaluation of last seven years maternal mortality in Manisa, Turkey

Objective: In this study, we aimed to evaluate the last 7-year rates of maternal mortality and the causes of maternal mortality in Manisa including Aegean region in the western part of the country. Study design: Maternal mortalities in Manisa determined by Maternal Mortality Commission were examined between January 1, 2006 and December 31, 2012. The classification of maternal mortality was performed as directly, indirectly, and incidentally. The annual rates and numbers of maternal deaths, causes of death, and demographic data were obtained from the records. Maternal mortality ratio is calculated as the number of women who die during pregnancy and childbirth, per 100,000 live births. Results: A total of 32 maternal deaths cases were reviewed between 2006 and 2012. A total of seven incidental maternal deaths of 32 were not evaluated. A total of five direct maternal deaths and 20 indirect maternal deaths were recorded. Maternal mortality rate (per 100.000 per live births) was 28.86 in 2006. This ratio decreased to 10.7 in 2012. Considering the leading causes of maternal death, the diseases of the circulatory system complicating the pregnancy and puerperium (28%) rank first. When direct maternal deaths are only evaluated, the most common cause was hemorrhage, which was followed by the disseminated intravascular coagulation. In all, six over eight (42%) maternal mortality in which delay model was detected were recorded as matched with third. Conclusion: In conclusion, an incentive to demand primary pregnancy advisory service is necessary for minimizing indirect maternal deaths and the need of medical staff must be fulfilled. Postpartum monitoring will be performed during the postnatal period especially in the first 24 h. Sensitivity must be showed for the training of medical staff that will perform emergency obstetric care when required.

Ductus venosus doppler flow velocity after transplacental and non-transplacental amniocentesis during midtrimester

Objective: We aimed to evaluate ductus venosus Doppler waveforms before and after amniocentesis in order to investigate any effect of amniocentesis on fetal myocardial hemodynamics. We also evaluated the umbilical artery, uterine artery and fetal mid-cerebral artery Doppler waveforms in order to investigate any relationship with ductus venosus Doppler changes. Methods: The study population consisted of 56 singleton pregnancies having genetic amniocentesis. Twenty seven of them had transplacental needle insertion; whereas 29 of them had non-transplacental amniocentesis. Uterine artery, umbilical artery, mid-cerebral artery and ductus venosus pulsatiliy index and resistance index were measured just before and after amniocentesis. Results: Amniocentesis does not cause any significant changes in fetal ductus venosus Doppler waveforms. There is also no significant changes in uterine artery, umbilical artery, mid-cerebral artery pulsatility and resistance index. Conclusion: Amniocentesis-whether transplacental or not- does not cause any significant effect on fetal myocardial hemodynamics.